Bruce Dow, M.D.

Dissociation and Dream Revision

Dissociation, in the realm of psychology, refers to detachment from one’s immediate surroundings.  Dissociation can range from mild to severe.  Mild dissociation takes the form of distractibility.  Severe dissociation may involve significant periods of time, and is often related to PTSD.  One form of severe dissociation, dissociative identity disorder (DID), formerly known as multiple personality disorder, involves multiple personalities, each dissociated from the others.  Both PTSD and DID can result from severe sexual abuse in early childhood.  

Many combat veterans with PTSD, but not DID, have significant periods of dissociation.  One Vietnam veteran patient of mine experienced dissociation while driving his car.  He had no problem driving safely, but would often miss his exit from the freeway, and have to turn around and come back, sometimes involving many extra minutes.  He had no recollection of events occurring during his temporary dissociative lapses.

Dissociation during severe trauma from which one cannot escape may have originally served a protective function, reducing emotional overload to the brain.  Why do people continue to dissociate after they develop PTSD?  Most likely they experience a trigger, a sensory stimulus (a sight, sound smell, or skin sensation) that reminds them of a past traumatic event.  The memory brings back unpleasant emotions from the past, possibly including a flashback, a vivid re-creation of the trauma scene.

If the memory/flashback is sufficiently intense and unpleasant, the PTSD sufferer may utilize dissociation as an avoidance technique.  The memory and its accompanying emotions are blocked, and the flashback goes away, at least temporarily.

Nightmares can cause dissociation as well.  My patients with PTSD sometimes say they are aware of having nightmares, but cannot recall details.  They have an ominous feeling, a sense of dread or disgust, and wake up sweating, with their heart racing.  They say they aren’t sure whether their nightmares are recurrent, since they can’t remember the content.

Many people with PTSD continue in this way for years, not wanting to expose themselves to traumatic memories.  Instead, they become repeatedly exposed to flashbacks and nightmares, which cause retraumatization.  PTSD, once established, tends to get worse rather than better unless effective treatment is initiated.

Effective treatment of PTSD involves breaking through dissociative defenses and confronting the trauma, however frightening this may be.  A therapist may be needed for support in this endeavor.  Dream revision therapy is one of the least traumatic ways of breaking through dissociation and avoidance.  This is because dreams are often symbolic or metaphorical.  One can work with the symbolism, within the metaphor, reducing direct confrontation with the original trauma.  It is often easier to face up to one’s nightmare than to directly face up to one’s original trauma.

However, dream revision therapy requires remembering one’s dream.  Dissociation may prevent this.  How can one overcome dissociation that occurs during and after a nightmare?  What can we do to remember our dreams more frequently and effectively?

The first step is simply to try.  It can be helpful to see a therapist.  During my psychiatric training I had weekly therapy sessions with a psychoanalyst.  He wanted me to tell him my dreams.  This was difficult for me at first, but over time I became much better at remembering them.  I kept paper and pencil near my bed, and wrote down my dreams whenever I could in the middle of the night.  Eventually, this became a habit, and I got quite good at it.  If you wait until morning to remember your dreams from the middle of the night, you may have nothing left but vague impressions and feelings.

Another trick is to set your alarm clock for late in the night (4-5AM), when you have a pretty good chance of being in the middle of a dream.  If you awaken directly out of a dream, there is about an 80% chance that you will be able to remember it.  I was able to affirm this myself by awakening people in a sleep lab in the early 1990’s while doing a research fellowship on sleep and dreaming at UC San Diego.

In the sleep lab we awakened people when their brain waves and eye movement recordings indicated they were in rapid eye movement (REM) sleep, the phase of sleep most closely associated with dreaming.  There are now several electronic devices on the market that can be set to wake you up at home when you are in REM sleep.  These devices, ranging in cost from $100-300 dollars, are known as “sleep cycle alarm clocks”.  They are safe and non-invasive.  Using such a device on a regular basis may increase the likelihood of awakening yourself in the middle of a dream so you can write it down.

Dissociation could have been useful at an earlier time in one’s life as a mechanism for avoiding traumatization, but if you are suffering from PTSD and having dissociation, it may be best to try to break through the dissociation and “TAKE CONTROL OF YOUR DREAMS”.  This is the title of a book I am in the process of getting published.  Once available in the marketplace, it could serve as a manual to help people change their dreams and recover from PTSD.  Recently I demonstrated the dream revision technique during an interview with Michele Rosenthal on her excellent weekly call-in radio show, Your Life After Trama. Listen to it here.